Name of the Procedure:

Laparoscopy, surgical; urethral suspension for stress incontinence
Common names: Bladder neck suspension, Marshall-Marchetti-Krantz procedure

Summary

Laparoscopic urethral suspension is a minimally invasive surgical procedure aimed at lifting and securing the urethra to help prevent urine leakage during activities that increase abdominal pressure, such as coughing or exercising.

Purpose

The procedure addresses stress urinary incontinence (SUI), which occurs when physical activity or exertion causes unintentional urine leakage. The goal is to improve bladder control and reduce or eliminate incontinence episodes.

Indications

• Symptoms include:
  • Urine leakage during physical activities
  • Persistent SUI affecting daily life
• Patient criteria:
  • Confirmed diagnosis of SUI
  • Failed conservative treatments such as pelvic floor exercises or medications

Preparation

• Pre-procedure instructions:
  • Fasting typically required from midnight before the surgery
  • Adjustments to certain medications, especially anticoagulants, under medical advice
• Diagnostic tests:
  • Urodynamic studies
  • Urinalysis
  • Physical examination and medical history review

Procedure Description

1. Anesthesia/Preparation: The patient receives general anesthesia.
2. Insertion of Laparoscope: Small incisions are made in the abdomen, and a laparoscope (a thin, flexible tube with a camera) is inserted.
3. Urethral Suspension: The surgeon uses specialized instruments to lift the urethra and bladder neck, securing them with sutures or a mesh to supportive structures near the pelvic wall.
4. Closure: The instruments are removed, and the incisions are closed with sutures or surgical glue.

Duration

The procedure typically takes around 1 to 2 hours.

Setting

Laparoscopic urethral suspension is usually performed in a hospital or outpatient surgical center.

Personnel

• Surgeon (usually a urologist or gynecologist)
• Surgical nurses
• Anesthesiologist
• Surgical technician

Risks and Complications

• Common risks:
  • Bleeding
  • Infection
  • Pain at the incision site
• Rare but possible complications:
  • Injury to surrounding organs (bladder, bowel, blood vessels)
  • Urinary retention or difficulty urinating
  • Recurrence of incontinence
  • Vaginal or pelvic prolapse

Benefits

• Improved bladder control
• Reduction or elimination of urine leakage
• Enhanced quality of life
• Benefits typically realized within a few weeks post-surgery

Recovery

• Post-procedure care:
  • Pain management with prescribed medications
  • Instructions on wound care and hygiene
  • Avoiding heavy lifting and strenuous activities for several weeks
• Follow-up:
  • Typically, a follow-up appointment within 1-2 weeks
• Expected recovery time:
  • Full recovery generally expected within 4-6 weeks

Alternatives

• Non-surgical options:
  • Pelvic floor exercises (Kegels)
  • Medications
  • Pessary device
• Other surgical options:
  • Sling procedures
  • Colposuspension
• Pros and cons compared to laparoscopy:
  • Non-surgical options are less invasive but may be less effective.
  • Other surgical procedures may be more invasive and have longer recovery times.

Patient Experience

• During the procedure:
  • Minimal as the patient will be under general anesthesia
• After the procedure:
  • Mild to moderate pain managed with medication
  • Possible temporary urinary discomfort or catheter use
  • Gradual return to normal activities with specific restrictions on physical exertion